临床耐碳青霉烯类肠杆菌科细菌对头孢他啶 /阿维巴坦的药物敏感性分析

目的　分析携带不同碳青霉烯酶的耐碳青霉烯类肠杆菌科细菌 (carbapenem-resistant Enterobacteriaceae，CRE)对头孢他啶 /阿维巴坦（ cerftazidime-avibactam，CZA）的药物敏感性，为临床合理精准用药提供依据。方法　采用药敏纸片扩散法（ K-B法）对烟台毓璜顶医院 2018～ 2020年临床分离并保存的 98株非重复 CRE菌株进行 CZA的药敏试验，并对 CZA抑菌圈在 20~22mm的菌株用微量肉汤稀释法 (broth microdilution method，BMD)进行验证，聚合酶链反应（ polymerase chain reaction，PCR）方法检测其碳青霉烯酶型，分析产不同碳青霉烯酶的 CRE菌株对 CZA的药物敏感性。结果　烟台毓璜顶医院 CRE菌株以产金属 β -内酰胺酶为主，占 72.45%，总体对 CZA敏感率为 23.47%。CZA对单产丝氨酸酶（ blaKPC，blaOXA-48）的 CRE敏感率为 100%，对单产金属酶（ blaNDM，blaVIM，blaIMP）的 CRE耐药率为 100%，对同时产丝氨酸酶和金属酶的 CRE菌株和对不产酶的 CRE菌株敏感率分别为 25.0%和 83.3%。结论　携带不同碳青霉烯酶的 CRE菌株对 CZA的药物敏感性不同， CZA体外药敏试验有必要在临床开展，同时需增加酶型检测方法指导临床精准用药。

Drug Sensitivity Analysis of Clinical Carbapenem-resistant Enterobacteriaceae Bacteria to Ceftazidime/Avibatan

Objective　To analyze the drug sensitivity of carbapenem-resistant Enterobacteriaceae (CRE) with differentcarbapenems to Cerftazidime-avibactam (CZA), and provide the basis for clinical rational and accurate drug use. Methods　Atotal of 98 non-repeat CRE strains isolated and preserved in Yantai Yuhuangding Hospital from 2018 to 2020 were tested forCZA drug susceptibility by K-B method, and a broth microdilution method (BMD) was used for strains with CZA inhibition zoneof 20~22mm, the polymerase chain reaction (PCR) method was used to detect the carbapenase type, and the sensitivity of CREstrains producing different carbapenases to CZA was analyzed. Results　In Yantai Yuhuangding Hospital, the CRE strain wasmainly metal-producing β -lactamase, accounting for 72.4%, and the sensitivity rate to CZA was 23.5%. CZA was 100% sensitiveto serinase (blaKPC, blaoxa-48), 100% resistant to metalase (blaNDM, blaVIM, blaIMP), and the sensitivity rates of CRE strains producingserinase and metalloenzyme and CRE strain not producing enzyme were 25.0% and 83.3%, respectively. Conclusion　CRE strainscarrying different carbapenases had different drug sensitivity to CZA, so it is necessary to carry out CZA drug sensitivity test invitro in clinic, and at the same time, enzyme type detection method should be added to guide clinical precision drug use.